Cillian Murphy’s lessons on technology

Far more nuance, subtlety and evidence is needed when it comes to adopting new technologies, writes Fraser Battye, head of policy at the Strategy Unit

Cillian Murphy. Owner of the most expressive eyes on the planet. While playing J. Robert Oppenheimer, those eyes displayed an attitude towards technology that we could all learn from.

Watching the first ‘successful’ test of a nuclear bomb, Murphy’s eyes were a picture of tortured ambivalence. Knowing that his invention could defeat one evil (Nazism), while creating others (existential risk), he looked torn and conflicted.

I’ve perhaps read too much into Murphy’s eyes. But I think the point stands. And it’s a point which expands beyond the bomb and into invention, technology and its role in healthcare more broadly.

My claim is that the NHS is badly served by both techno-optimism and techno-pessimism.

Instead, we should be deeply ambivalent. I don’t mean ‘indifferent’. I mean conflicted, unsure, aware of contradiction – and, as a result, determined to use evidence as a guide.

I’ll make the case for techno-ambivalence over the following several hundred words. But you can experience it for yourself, right now.

What do you see as you read this sentence?

Digital Health is online only, so you will see a device of some sort. Now: mentally list some of the upsides and downsides that this device has brought to humanity.

There you go: ambivalence. Uncertainty while weighing out a mix of gains and losses – many of which will seem obvious, others of which won’t. Tinges of subtlety, doubt and not knowing.

Perfect. This is exactly the attitude needed to make wise decisions – in policy and services – about deploying new technology in the NHS. It is badly lacking.

Clearing the way for techno-ambivalence first requires us to hack back the extremes: both techno-pessimism and techno-optimism must go.

Techno-pessimism is easier to address. It has very few adherents, and their concentration in caves makes them unlikely Digital Health News readers.

I also imagine that very few readers would be without the fruits of medical science. Anaesthesia, for example, is a technology that looks close to being ‘all upside’ – especially when weighed against the alternative of leaving teeth marks on a strap.

So techno-optimism is the extreme that needs attention. It is rife.

Discussion of AI is perhaps the starkest current example. The implications for the NHS of the AI Opportunities Action Plan has been usefully examined by Pritesh Mistry of The King’s Fund and – albeit in snap reaction form – critiqued by Dr Jessica Morley of Yale University.

My analysis of the plan is far cruder.

I start by assuming that something with great benefit comes with commensurate cost and risk. Some think AI’s risks are existential, but the uniformly optimistic title and tone of the ‘opportunities’ plan suggests no such downsides.

When it comes to developing AI, we might – literally, metaphorically – be in an arms race.

I understand worries about the UK being underpowered and left behind, but an issue as serious as this requires care, nuance and evidence – not hope.

More generally, in trying to clear more space for ambivalence, I’d suggest that techno-optimism is only a sustainable attitude if:

It is your job to sell new technologies.

In this case, I understand – but politely discount – your perspective. As the writer Upton Sinclair reminds us: “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

You think that technological progress is the same as human progress.

This belief, popular in the 1990s – but apparently still with us – must rank among the most harmful beliefs of the age. Its adherents confuse technological advance – and perhaps GDP gains – as real, humanly felt, progress.

One cure would be to consider the staggering gains in human power brought about by technology, before seeking evidence of similar gains in our wisdom, ethics and politics.

Ambivalence results. Surely?

You are in a horrible bind and don’t know where to turn.

Many NHS decision makers are in a sufficiently terrible situation that they are vulnerable to wish-thinking. It is this group that needs most sympathy and attention. They will struggle to reach ambivalence: it does not give them ‘the way out’ that they crave.

They need help to get there.

The Strategy Unit is doing its bit. Our focus is on this group of hard-pressed NHS decision makers. And our contribution is – as ever – critical thinking, evidence and analysis.

Our most recent direct contribution on this topic was a discussion paper on the downsides of digital technology in health and care. I had the pleasure of presenting this work at a recent Strategy Unit ‘Insights’ event, run jointly with The Health Foundation and featuring (the amazing) Professor Trish Greenhalgh summarising her paper on general practice.

Our aim is to bring nuance to the discussion about the adoption of new technologies. Decision makers need evidence, not promises. If evidence is lacking, then care (and evidence gathering) is needed.

I know this sounds like a dull grind, lacking the fizzy excitement of breakthroughs and new possibilities. And yet the results will be better over the long-term.

Wisdom over whizzy. Ambivalence over optimism.

Oppenheimer over Barbie…

Fraser Battye is head of policy at the Strategy Unit – an NHS team dedicated to the use of critical thinking and the application of evidence. He has 25 years of experience analysing and advising on public policy, working at all levels of government from local to European. Fraser is a senior research associate at the Jesus College Intellectual Forum in Cambridge.